This Angel is pissed off. I'm Nurse Anne and I work on large general medical ward in the NHS. These are the wards with the most issues surrounding nursing care. The problems are mostly down to intentional understaffing by hospital chiefs that result in a lack of real nurses on the wards.
"The martyr sacrifices themselves entirely in vain. Or rather not in vain, for they merely make the selfish more selfish, the lazy more lazy and the narrow more narrow"-Florence Nightengale

I've ceased with the pre-shift ritual of meditating in my parked truck along with a soothing piece of music. No more prayers to God en route to work asking for more patience, more humanity, more understanding. I have accepted the fact that it will be no different than any other night in the Emergency Department, no matter if I blare Yanni's rancid piano etudes or make a promise to God to pass out my own body parts to the discharged patients as they leave. Nothing will change. I use to look forward to making a difference in someone’s life, helping a poor soul whose body has given out. Those moments are few and far between now. Instead, I resign myself to the fact that the next 12 hours will be spent pasting a fake smile on a tired body, going through the motions of caring, repeating ready-made lines of false concern and giving out medical advice that fall on deaf ears. I use to feel important in my role as Charge Nurse at a major ER of an inner-city charity hospital. Now, as I sit in my truck at 6:45 in the evening, gangster rap blaring, I send out a quick impromptu message to God..... "Please God, allow me the opportunity to be gainfully employed 12 hours from now."

7:02 PM-

I receive a quick report of the clingons and leftovers who haven't made it out of the department by change of shift and to no surprise to myself and the night crew, a few names are all too familiar and the reports of their latest "illness" easily recitable from memory. The usual apologies from the day crew for not getting them out before we arrived go unnoticed. A shrill screech from one of the psych beds startles no one. We all just look up from within the "safe" confines of the nursing station, confirm that our overweight security force is camped out beside the room, shake our heads briefly and go on about our business. We go through the ritual of taking our own baseline vital signs, popping a few Xanax and removing sharp objects from our pockets. Patient safety is important and we wouldn't want to accidentally stab one of them repeatedly in the chest.

7:17 PM-

My primary job aside from direct patient care is triage. Initial interview, vital signs, brief medical history, current medical problem, current medications, height, weight etc etc. My first of 35 or so fits the typical profile of this or any other ER in the country. 40 year old, female, morbidly obese, diabetic, hypertensive, multiple psych meds, very little English, less common sense, no means to pay. She complains of the usual nausea, vomiting, diarrhea and generalized abdominal pain. She's already spent thousands of dollars of other people’s money last week for the same complaint. She didn't fill her scripts, didn't follow up with her Gastroenterologist as requested and by no means was this 300 + lb, truffle hunting leech going to alter her diet one iota in order to prevent another attack of diverticulitis. Her idea of a "Clear Liquid Diet" was a bucket of chicken and bowl of menudo an hour prior to her arrival. So here she is, totally oblivious as to why she is still sick. Non-compliant with her meds, non-compliant with the discharge instructions, follow up or diet instructions, which included a bland, low-fat, liquid diet for a few days until she was able to tolerate semi-solid/or solid food.

She bitches profusely when she is not brought straight back and put into a bed, instead she is sent back out to the waiting area for a lengthy wait. We are full and busy with the truly "emergent" patients but she can't seem to fathom this. She barrels through the exit door, into the waiting area calling me every name in the book (in Spanish) and swearing to never come back again. "PENDEJO!", she mutters. Oh, she'll be back.

"NEXT"!

7:31 PM-

My 3rd patient is a 23-year-old mother of 3, the oldest being 10. She has somehow mistaken our "EMERGENCY DEPARTMENT" for a pediatric clinic and wants her brood "checked out" because they feel "hot." No temperature ever taken at home, no Tylenol or Motrin given before the decision was made to spend $1500.00 of other people's money and to waste our time babysitting 3 snot-nosed, unkempt ankle-biters who are no more sicker than the man in the moon. I usher them one at a time onto a scale for weights and am not surprised that each is twice the size they should be at their particular ages. One, I have to pry finger foods and a "Big Gulp" from their obstinate little mitts prior to the weight so as not to inadvertently add 5 lbs to his already triple digit reading. The electronic scale beeps incessantly and reads, "ONE AT A TIME, PLEASE."(Ok, not really) With all their vitals being normal they are ushered out into the waiting area where they eagerly pounce on the furniture and run around like the defensive line for the Attention Deficits.

I am verbally attacked by my obese belly pain lady, who has "been waiting for hours" (uh, how about 20 minutes). I instantly notice the "positive Cheetos sign" on her fingers and around her lips and remind her that the sickest are seen first and to have a seat. She tosses me a "Pincha Pendejo" and rumbles back to her seat. I sneak in a quick call to God asking that he makes sure she looks before she plops back down in her chair(s). I can hear the intercom announcer now, "CODE BLUE TRAUMA, ER WAITING ROOM." I mentally picture the scenario of the code team spending the next hour removing baby Julio from the rectum of a 300-lb verbally abusive Hispanic woman. "NEXT"!!

9:21 PM-

I've survived the dinner crowd with my job intact and make my way back to the treatment area to assist the rest of my team in the treatment of the patients who were lucky enough to make it back ahead of the non-emergent riff-raff. I make my way to the EMS radio station when I hear....."Unit 842 code 2 patient report"....we have a 102 year old nursing home patient,....found unresponsive on the floor....no IV....she's now awake, combative, confused, covered in stool, incontinent of urine, blah, blah, blah..." The report from the nursing home prior to her EMS transport reveals that this patient had a tendency to "dig out stool from her rectum when constipated." "Oh, that's just friggin lovely"

Our lovely elderly finger painter arrives, covered in poop from head to toe. EMS personnel smirk as they wheel her by, updating us as to any changes en route. Nope, no changes, except that now she's given up the fight and is again unresponsive and her breathing more shallow. In an instant her breathing stops and is immediately rushed to trauma 1 where CPR is initiated. "CODE BLUE ER-1, CODE BLUE ER-1."

9:57 PM-

"Time of death, 9:55" is belted out by the code team leader. "She never stood a chance." "It was her time." "She had a long and good life." Blah Blah Blah Blah. She had a horrendous death. Born covered in amniotic fluid, but certainly a proud moment for her parents one can be sure. She died, however, covered in shit, piss and bedsores. The nursing home where she spent her remaining days in agony and perpetual loneliness should be burned to the ground. No family, no attention, nowhere near as prominent and proud as she once was. Left to waste while the understaffed workers at Our Lady of the Perpetual Petri Dish took their extended breaks and pillaged through her personal belongings. A courtesy call to the nursing home is placed telling them that Mrs. Mullins will not be coming back and has been transferred to the ECU (Eternal Care Unit). I hear, "Whew, thank God.....CLICK."

10:22 PM-

Our usually bevy of drug-seeking, bipolar, depressed, suicidal, Xanax, Vicodin, Demerol hounds arrive as scheduled with multiple and varied complaints of, migraine headaches, chronic back pain, stress, anxiety, fibromyalgia, blah, blah, blah....! They are easy to spot, almost always familiar, with the same ole' story. Most we know on a first name basis. They are all, coincidentally, allergic to the same medications; Tylenol, Motrin, Vistaril, Toradol, Aspirin or any other non narcotic or harmless placebo we've attempted to quell their "pain" with in the past. The only thing that works is "Demerol" and they must have a large supply of Vicodin in the form of a prescription when they leave. (Vicodin has Tylenol in it but apparently doesn't cause a severe allergic reaction when mixed with euphoria,....go figure!)

Security is usually called, for to tell them "no drugs tonight" is just asking for a fight. $1000.00 later of other peoples money and they usually leave with their buzz on and their script for Vicodin. But usually not before asking for a "shot for the road" or additional scripts for anxiety (preferably Xanax) or sleep aids. 30 pills are often the number of pills given, depending on the frequency of the prescribed dose. This usually last a few days for the typical drug seeker and then they'll usually return with more "pain" and a hungry monkey.

In the age when Doctors are sued for both under treating pain OR for prescribing too many narcotics and "getting them addicted", we medical personal are caught up in the proverbial "catch 22". More often than not I have been written up and on several occasions was at a point where my job was in jeopardy because I challenged their pathetic lies whenever these low-life drug addicts invaded our ER's. Now I just shut up, shake my head and pray for an overdose.

11:12 PM

Waiting Room intercom is ringing off the wall. "...how long will I.......can you tell me where I am on the list......Donde esta su Doctor.......I can't find my child........the dingo ate my baby.....PINCHE PEDEJO, I BEEN HEER FER TWO DAYS AND MY ASS FEELS LIKE SOMEONE POURED SALSA RIGHT UP MY..........click.

Midnight in the garden of good (for nothings) and the evil (doers)-

After a flurry of non emergent triages, (sore toe, "the shakes", anal abscess, foreign bodies in the nose, ears and stomach of a 2 year old, blah blah, blah) I call in an astute, well dressed, middle aged white male, who is walking quite gingerly and refusing to sit. Differential diagnoses race through my head, back pain, abdominal pain, rectal abscess,. or perhaps....no!....NO!......NOOOOOOOOOOO!

Yes!

The story goes (and it is a common one) that he and the Mrs. were "experimenting" in bed (against his wishes, no doubt) when a vibrator was jammed in his keester and is now painfully out of reach. Given the nature of the "injury" he is whisked back to a private room, placed on his side, lubed up like a 57 Chevy, and a valiant effort is made to retrieve the 12 inch "perpetrator with ribs" from his large bowel. All to no avail. At one point we had a hold of the foreign body (actually, it was made in the US) but the colon wouldn't let go of it's new found cylindrical friend. We tugged, twisted, yanked, pulled, all efforts proving futile. Finally the physician stopped, exhausted from the tug-o-war match, with the forceps, commonly used to removed big headed babies, protruding from the prominent lawyers butt, he made the decision to call in the surgical team. All efforts to remain professional, however, fell by the wayside when, during a moment of silence, a low buzz was detected in the room. Had the blood pressure cuff inflated? Were the incandescent lights buzzing? Was the TV on?

No, no and no. We looked at the forceps and noticed they were vibrating uncontrollably, instantly realizing at that point that this thing was STILL ON. A mad rush by the scant crew to the exit door of the private room was attempted as to not embarrass this local professional with our boisterous laughter. No dice.

We will all eventually be written up and apologies made for our "unprofessionalism and disregard for the patient’s privacy and mental well being". That's ok. We needed that to preserve our own mental well being. Still proving that laughter is still the best medicine.

1:02 AM

Ten triages later and its dinner time for this mentally worn crew. We retrieve our food, locate it to the middle of the nursing station and we eat. Not all at once, mind you but usually a bite at a time. Eat a French fry, go wipe an ass in ER-1, a bite of a Big Mac, go clean up cherry cool-aid flavored vomit in ER-4, a sip of Dr Pepper, then physically restrain a combative Scitzo-effective patient. By 2:15 we have polished off the last bite of a hardened burger, ate our last stale French fry and sucked down the last gulp of our watered-down soda. A soda that is now as warm as fresh urine and food that is as cold as Mrs. Mullins in ER13.

2:30 AM-

Ahhh, my favorite time during the entire shift is upon us. The "Last Call at the local bar crowd" (LCLBC) start to pour in to the front entrance, while EMS brings the ones who got the shit kicked out of them through the back ambulance entrance. "Santa Rosa, this is unit 842....we are coming code 2 trauma with a 19 year old male.....closed head injury....intoxicated...combative....soiled....bloody.....no insurance.....blah, blah,blah.

The same ole song and dance spews from this patients bloodied spout as he is wheeled into Trauma-2......"I was just minding my own business"......"I only had two beers"....."I don't do drugs"..... "Can I get something to eat?" "RAALLLLLLPHHH!" "Housekeeping to ER Trauma-2, Housekeeping...."

I am ushered into the staff break room for a "time out" and reminded by the night supervisor that the cost of the intercom will be deducted from my paycheck.

4:18 AM-

Our portly female beast of a woman is finally ushered back to a room but not before mumbling under her breath as she brushes past me, "Pendejo"! A major "abdominal work-up" is ordered. 40 lab tests, urine tests, stool cultures, abdominal x-rays, Cat Scans, blah, blah, blah......She's placed in a gown that looks like curtains stolen from the Grand Ole Opry, and given the reminder "Opening to the back, please," tossed in for good measure. ("Lord, give me the strength to...........Oh forget it, never mind")

She's given a URINE cup as she bounces her way to the bathroom. She fills it with STOOL. "Housekeeping to ER, STAT."

Can't find a blood pressure cuff large enough so we must take a chance at an erroneous reading by placing it around her calf or forearm. The hydraulic bed grunts and groans with ever twitch and shift from this woman of substances. She continues to bitch and moan and will eventually file a complaint with (in) human resources, I am sure. Multiple attempts at IV access finally yields a vein that hasn't been choked off by the mass of arm fat and IV fluids are initiated. After a quick assessment by the ER physician she is off to radiology, with a little 120 lb tech pushing 600 lbs of patient and bed up to the 3rd floor for a series of $3000.00 radiologic exams. X-rays that were done just last week and that she has no intention or means to pay for. It would have been easier (and cheaper) had she driven to Sea World instead. Certainly more accommodating for a woman of her stature.

5:57 AM-

Multiple early morning stragglers are triaged and sent to wait. The foul odor of urine, poop, BO, booze, vomit, etc, permeates the air. "One Hour Left", I thought. We get all the results of the voluptuous Ms. Hinojosa's tests back and surprise, surprise...."Diverticulitis." Perhaps this time she will be compliant with her meds, compliant with her diet, compliant with her follow up, compliant with life. "Fat chance,"I thought. (Pun intended).

Her IV is removed and a half gallon of fat globules ooze from the harpoon hole. She is hoisted off the bed with the help of several departments within the hospital; half of who will call in sick tomorrow with severe back spasms. The battered stretcher which now resembles a low-rider after a major accident is towed to the back for repair. Ms Hinojosa is discharged but not before requesting a breakfast tray. Request denied.

Off she goes to the local "Taco Cabana" for a flurry of assorted breakfast tacos and a bowl of menudo. "She you in a few days, Ms Hinojosa."

"Pinche Pendejo!"

6:47 AM-

The dismal faces of the morning crew are evident as they reluctantly make there way in, some still in mid-prayer, the newer nurses with walkman's on, listening to ocean waves or cricket noises saturated with Muzac. A quick report is given to the mentally exhausted night crew and apologies made for the missing bed in ER 3 and the dead body in ER-12.

7:07 AM-

Each member of the night crew, each with a phone in hand, are awaiting the instant the clock strikes 7:08 where, with lightning speed, a flurry of buttons will be punched to clock out, ending another horrendous but typical night in the ER.

7:47 AM-

I pull up to my apartment and sit quietly in my truck. I recall the night’s events and wonder if I had made any critical errors in care or judgment. I mentally prepare for the answers to the complaints made the night before by this unique ER culture of ignorant, non-compliant, abusive, poor, helpless, drugged-up, psychotic, dregs of society.

I say a prayer for Mrs. Mullins and her family and curse all those who've abused the system in the last 12 hours, spending thousands upon thousands of dollars of other people’s money but contributing nothing to society what-so-ever. Once I deem that I will have a job come 6:45 that evening, I ease my tired body and shattered mind out of my vehicle, meander up to my apartment and into bed, hungry, frustrated, angry. Where I will fight the demons for an hour or so until I am able to fall asleep. I don't. I am woken by a dream whereby the ER staff are all patients in the waiting room on a busy night. I am called into the back where a 500-lb female nurse is ripping my clothes off with one hand and swinging a 6 foot rectal scope in the other like a pair of numchucks in a Bruce Lee movie. The alarm clock sounds and I immediately spring up and grab my ass, praying that a 6-foot proctoscope isn't dangling precariously from it. It's not. I breathe a sigh of relief and make my way to the shower and into another fateful night of chaos and mayhem.

6:43 PM-

I pull up to the ER, park my truck and sit. I clip on my name badge, giggle as I read our "Mission statement" tattooed on the back. "To extend the healing ministry of Christ," it reads, and I take a minute to ponder that statement. I smile, acknowledge it's powerful and profound meaning and bow my head to pray. "Lord, today, give me your divine power to accept my responsibilities within this ministry. I pray that..."

Just then a beat up delta 88 rolls by on two wheels, with a definite lean to one side. I watch as they take up two parking spaces in the "staff" lot and out pops Ms Hinojosa. I cringe. She leaves a trail of urped-up fajita and menudo through the patient parking lot, into the physicians parking area, towards the ER entrance. Anger churns inside me and I hang my head, looking down at my badge and the mission statement on the back. I try desperately to find the peace and pride I felt just 2 minutes earlier and I resume my prayer......"Lord,....I just.......If you could only find it in your heart to............OH FORGET IT!!!!!....... NEVER MIND."

Michael Brown is a Registered ER Nurse from Texas. He is currently taking no medications at this time.

Wednesday, 26 September 2007

I'm freaking out a bit here about what the next few days at work are going to be like. You can bet your ass that I am going to spend Friday getting screamed at by consultant surgeons and their registrar and SHO henchmen. Yep that's right...surgeons. But isn't Anne a medical ward nurse you ask?

Let me give you some background. Two weeks or so ago my acute medical mixed ward was shut down with no warning. Literally came into work and the doors were locked.

This was done because of financial problems but we were told that they were going to clean the bays. They moved half of the staff including me onto a new ward in a totally different specialty and the other half god knows where. Our new ward continues to be half their original speciality and some overflow medical as there are massive problems in A&E getting beds for medical patients. WE didn't have enough beds before my ward was shut. It's always been a huge problem. It has been chaos since the minute is shut and now.

The nurses on our new ward are a bit upset to put it mildly about taking our patients and our staff. The staff from my old ward (myself included) have no experience in this new specialty at all. I didn't even do any kind of training in this area in nursing school. The medical patients should not be near any of their patients for many reasons. But we have no choice to have them altogether as they are so short of beds we just put them where we can.

We have not been given nor will we be given any kind of orientation or training in our new area. The day after our ward closed and we were put onto the new one our staff and the staff on the new ward were left to it. So we divided the ward into medical patients and nurses and new specialty nurses and their patients and acted like 2 teams. We thought that this would be the best way to go. We had no guidance from the powers that be. We just decided to let the medical nurses and medical patients make one team and the speciality patients and their nurses make another team, and we tried to keep them physically separate.

The powers that be came down and said oh no you guys must integrate none of this separation shit and then they abandoned us to our fate. They were really very nasty actually. You would think that the matron for the new specialty (and our old one) would have been around to guide us or something. None one has been around providing any leadership really. Just band 5 staff trying to do their best. Matrons are like ghosts. We all know they exist but have never seen one.

The staffing has been horrendous. Only my hospital could combine 2 wards and have worse ratios with less beds. How the fuck does that happen. We have actually been working with worse numbers than what we usually have. The first week down there was nuts because we couldn't actually find anything. No one showed us around. For the most part we are getting along with the staff down there and are trying to stick together but we are all so overwhelmed. No one has any time to teach the other about their speciality. Mistakes are happening and the complaints are flooding in.

It is working out that a lot of the medical nurses are having to take bays of patients that are mostly from the new specialty with no one to help. It is working out that there are many shifts when nurses from the original specialty on this ward are not there at all so the medical nurses are fumbling along trying to figure it all out as they go. This is happening a lot and I have no idea why.

I am on the next 2 late shifts. It will be just myself and a newish grad who doesn't speak much english from my old medical ward as well as an HCA from my old ward. There won't be any matrons from this speciality around. Nurse manager is off. 20 of the 30 beds are the speciality patients rather than medical patients. I am bricking it. I have no experience in this area and it looks like I am in charge. I hope someone high up gets a clue before tomorrow and does something. People who have tried to make a case for why this is bad bad bad have been labeled complainers and trouble makers.

So I will be possibly in charge of an area I am not familiar with. Same thing happened to one of my medical colleagues last week. All hell broke loose because the ward was totally staffed by medical nurses who didn't have any training or experience in the new speciality. Chaos ensued when patients were coming back from theatre with epidurals etc. Where is the leadership? They promise to send more help and it never happens. Last week I was on a dayshift with all medical nurses and I asked for help....and guess who they sent me....a medical nurse from another ward! What the fuck? She refused to do it and pissed off back to her ward...no relevant experience.

Later on the sent me an RN from another ward similiar to this specialty and he saved our asses. I have to say that I love that nurse. However he swore that he would never come back to this chaos and disorganised mess. Not only are most of the nurses unfamiliar with this specialty but they are so short staffed that they can barely catch their breath. The ward is too short for anyone to go off for any kind of training. No one who values their pin number wants to step foot in this place. Remember my earlier posts? If anything happens it will be the nurse that gets busted rather than the management. That is how the law regarding this stuff works.

How does this shit happen? Where are the highly paid matrons? Why aren't we allowed to have any staff? Why did the managers think that this little stunt would work? What are these people smoking and can I have some please?

First of all the powers that be are like everyone else. They think that nursing is a simple little job where one makes beds and hands out pills. If one can do that on a medical ward they can do that on another specialty ward right? WRONG. This is what I was getting at in my "which one is the nurse and does it matter" post. Stupid ignorant ass fucktarded attitudes and ancient nurse stereotypes cause mega problems that affect patients very badly.

I am freaking out big time. Someone say something positive to make me feel better please. Maybe I'm just a total wuss but I am truly upset about this. There is lots of stuff I can't go into detail about. If I am a sissy we all are because my colleagues aren't in a very good place emotionally either right now.

This bullshit is happening all over this country and it is going to get worse. Lots of wards/beds are being closed and staff shuffled about. I have friends in other trusts who have told me similiar stories that would scare the shit out of you but they have asked me not to write about them.

I live about 2 minutes from an airport. Who thinks I should just grab the next flight out of the country? I may actually look into the airline stewardess thing after all. I bet they would like to have an RN on board right? I wouldn't have to commute as far to work. I'll go away and have a think.

I hope that when the "appropriate Government Department" sees this petition that they don't immediately dismiss it as costing "too much money". Everyone except for stupid fuck politicians knows that more nurses per patient means that we have LESS EXPENSIVE COMPLICATIONS, DEATHS, COMPLAINTS, ETC ETC. The money saved far outweighs the cost of employing more staff. Well, that is the conclusion of everyone who has ever seriously studied and researched this issue. More research in the UK is needed but someone in this country is going to have to give a damn first.

Meanwhile Gordon Brown is going to piss money away trying to make the hospitals cleaner because that is supposed to eradicate MRSA and C-diff. Jesus Christ pass me the fucking Vodka. It's now official: Journalists and Politicians have never taken a basic microbiology course. Yes clean hospitals are important. Yes, hand washing is important. Yes MRSA definitely sucks ass.

You won't see the end of hospital acquired infections no matter what you do. You can reduce the number and good hygiene is always important for too many reasons to list here.

American hospitals are all private with 24 hour housekeeping/cleaners and mostly private rooms that are en-suite and they have a huge MRSA problem. Most people are colonized with MRSA but if you are healthy you don't know it. When you become elderly, frail, immunocompromised and have a nice open wound you might develop a problem. It's proven that most people are actually coming into hospital with mrsa on their person already.

Staph aureous has always lived on humans and caused problems in the weak and frail and sick since before jesus was born. Now this very same bacteria is antibiotic resistant as a result of overuse of antibiotics. Staph Aureous (SA) is now methicillan resistant (MR) so we now have MRSA. They are estimating that up to 70% of the population is carrying MRSA on their person. An infection control doc I once worked with in the States says that it is much higher than that number. Swab the locker room and equipment of the nice little gym you pay to work out in and you will find MRSA galore.

In the News of the World, he vowed that over the next 12 months all hospitals would be restored to a pristine state of cleanliness to rid them of infections such as MRSA and Clostridium difficile.

Turnover of beds

He said: "A ward at a time, walls, ceilings, fittings and ventilation shafts will be disinfected and scrubbed clean."

There are many hospitals in England that are closing down wards and are heaving with patients that they cannot find beds for. The beds they have are filled with elderly patients who stay in hospitals for months and months because there are not enough long term care facilities.

Now Gordon is going to close down wards for cleaning for a week at a time! Fantastic! What a terrific idea! Too bad no one at the hospitals ever thought of that before! Oh wait. Actually they did think of it BUT THERE IS NO PLACE TO PUT THE FUCKING PATIENTS. They are overwhelmed already. They can't meet their A&E targets because there are no beds. We can't discharge most of our elderly medical patients because even though they are medically fit and do not need to be in hospital...there is no one to care for them. These people aren't safe to be left alone for 2 minutes in a padded locked room. Family members refuse to agree to nursing home care, are unable to look after the patient themselves..etc...etc. Takes months for social services to get their finger out. We have people for 4-6 months. Oh yeah and then there is the fact that you can deep clean the wards as much as you want..the patients will all be crammed into another place constantly coming in and going out....everything rush rush rush. I think Gordon smokes crack I really do.

You can bet your ass that Gordon is going to force the hospitals to close down wards for cleaning without providing the hospital with any kind of assistance (financial or anything) to deal with the crisis that is going to ensue from lack of beds etc. We recently lost a 35 bed ward and chaos has been ensuing ever since. Total fucking chaos from the minute it was closed and until right now. It's a mess. They couldn't afford to keep it open, they couldn't afford to lose the beds. Most of the hospitals in this country can't handle a loss of beds for any short period of time. How is he going to pull this off?

I do, however, like the idea of going to work and scrubbing and cleaning the ward for a few shifts. Sounds like a vacation day.

Friday, 21 September 2007

Time to go off on a few tangents and let off steam. It's theraputic for me even if no one reads this longwinded crap.

Before I start I would like to deal with a misconception about highly educated nurses. People think that we think we are above bedpans and cleaning. This is just not true.

I have always said that the major problem with Nursing is this: People don't understand what a nurse is, what nurses do, how much they have to know, the amount of liability and accountability they take on, the amount of education they need to do their jobs, and the unbelievable amount of responsibility they have. They cannot differentiate between a Registered Nurse and a Nursery "nurse" and probably think they have the same level of education.

How do I know that the public is so freaking clueless? Because I read doctor blogs and then I hear people refer to their 17 year old niece who gets a job working in the hospital as an auxillary as "a junior nurse". Yeah. A Nurse. Yep. People think that employee who comes into their room to take a blood pressure is a nurse. Why did I work so hard to get the initials RN behind my name if people think that the trolley girl who serves tea is a nurse? Any female walking around the hospital in uniform is a "nurse". This is totally unnacceptable. If you analyze this further you can see some of the serious problems that can arise as a result of ignorance. Attitudes can Kill.

You think I am being petty? Walk into an airport and call an airline pilot "stewardess". Hell they all work in the same place so whatever right? Walk into a solicitors office and refer to the legal secretary as "solicitor"..why not they all work in the same place. Walk into a hospital and call the doctor "nurse". You all know not to do this yet you refer to an untrained but well meaning kid who simply makes beds and walks people to the toilet as "nurse" which is my legal title and I'm not supposed to get annoyed? If an HCA or an auxillary had to go through what I went through in nursing school they would probably flunk out. Yes I know I sound too much like Dr.Crippen when he is having one of his quacktitioner vs Doctor tantrums.

They (support staff) know that real nursing is a total bitch. Why do you think so many of them won't go off and become nurses even though their education would be free (in the UK) and they would make slightly more money? Why do all that work when one can have an easier (although backbreaking) job with no accountability and still get called "nurse". They are only on very slightly less than an actual nurse salary wise. The job is lightyears less demanding...even if they are breaking their backs doing all of the lifting, bathing, turning etc. I was an HCA once so I know the score. I used to think that HCA's did all the work and now I look back on that knowing what I know now and realise that I was just ignorant.

I worked my ass off through a rigorous 4 years at university where I was in lectures 8-12 hours a day and clinical placements on top of thaton the same damn day. I had to take university level chemistry, microbiology, anatomy and physiology 1 and 2, statistics, the pharmacology course from hell, and much more as well as nursing theory. The other students at this university could get shit grades barely above passing and still graduate but the nursing majors were kicked out if their final grade for any class went below an 80%. Two fuck-ups in clinical and you were gone and you didn't get your $40,000 a year tuition refunded. Okay I was on a full scholarship but I was still under an insane amount of pressure. While I was doing 8 hours of clinical a day on top of 8 hours of lectures in a single day the media studies majors were getting drunk and fucking around. Bastards make more money than me too.

We were going to be nurses and had to be better than the others. This is what we were told. Nurses have life and death responsibility and even small mistakes kill. Most other Uni grads won't have to deal with that or work in such a chaotic environment. They won't have to think as fast etc etc.

Nursing in the UK is no piece of cake either. There are two ways of becoming a registered nurse. One can either do a 3 year diploma AT UNIVERISTY, or a 3-4 year degree AT UNIVERSITY. Let me tell you something. The 3 year diploma is a lot tougher in many ways than your typical 4 year degree for non-healthcare staff at university. Any starting new grad RN walks into a job where he will have triple the responsibility and workload and accountability that a teacher, english major, or business major etc. will have. I have lost count of the number of people I know who have done nursing as a second degree and said it was shockingly harder than their first degree. They don't last long.

I have lost count of the people I know who have Bachelors degrees in other fields who have flunked out of diploma nursing. In places like the USA where an RN has a highter starting salary than most new grads we see engineers, teachers, accountants, computer majors and others going back to Nursing school because they want a higher paying job and they want to help people. In the UK we see people who go through some kind of mid-life and decide to switch careers into nursing because they feel that they have done nothing worthwhile with their other degree and they want a job that means something...they want to help people.

What do all of these people have in common? The vast majority feel that nursing school was the toughest thing they ever did yet it was cake compared to actually trying to function as a staff nurse on a general ward. I know 5 school teachers (2 with a masters degree who went back to nursing school. Three were located in the USA where nurses make more money and 2 were located in the UK where nurses make less money than a teacher. Only 2 of them actually made it through nursing school and none of them lasted more than a year as nurses. They were soon back to teaching and it wasn't because they have an aversion to shit and puke. They couldn't handle the information overload and the life and death responsibility, the nightmarish hours. The ones in the US took the pay cut and went back to teaching.

Sure nursing education is lacking in a lot of ways but it's a lot harder than you think believe me. Just because it isn't as hard and as long as medical school doesn't mean it is cake. Nurses need a good academic foundation as well as massive amounts of hands on training done IN THE RIGHT WAY. Years ago we had the latter and not the former. People died. Now we have the former but not the latter. People die. My belief is that nurses do need to have a 4 year degree as entry level BUT that doesn't mean shit without decent placements and mentoring and interships. You just can't have one without the other. You need both. But who wants to go to school that long to get paid less than a policeman?

In spite of these problems with nurse education, people who can legally call themselves nurses have worked hard to earn it. The 19 year old HCA who makes your bed has no idea what it takes to be a nurse. They have no accountability and don't have to make difficult decisions. They don't take responsibility for anything. They are working on my license. They do not understand all of the ins and outs of what I am doing and why. They hear in report that we have a patient with an HB that dropped fairly quickly who is still on 2 kinds of anti-coagulants for that clot and he now has maleena. He is in the bed next to the NBM guy who now has no IV access and a K+ of 1.9. I have to change some info here to comply with confidentiality but you get my drift. They hear these things but they don't know what that means or what's involved and they don't understand why I make a run for those guys as soon as I get out of report rather than "helping us" serve breakfast.

Even after completely 4 years of hell at Uni and graduating with a degree in Nursing I was STILL NOT LEGALLY ALLOWED TO CALL MY SELF A NURSE. I had to take a miserable hellish state board exam. I passed on the first go and then I was allowed to use the term nurse to describe myself without breaking the law for the first time. All this qualified me to apply for a job as a Junior D grade staff nurse in the UK. I paid my dues to the state board of nursing for my license and than the NMC. It costs money to maintain a license. Not an issue for support staff.

This unfuckingbelievable amount of ignorance regarding nurses, their legal responsibilities and their education leads to many things. Indirectly it leads to people suffering and getting shitty care.

First of all it's very easy for the powers that be to cull back the number of registered nurses and bring in untrained kids with nose rings, give them a uniform and teach them how to make a bed. The public doesn't really understand the difference between these employees and a "nurse". Their opinion of nursing as a profession goes out the bloody window. I have heard comments such as "an HCA does everything a nurse can do except give meds". You have got to be shitting me. I'll be writing about a day in the life of an RN in a later post and we'll discuss this.

This increase in non-professional staff and decrease in actual nurses is occuring at a time when patients are sicker and more complex due to advances in health care that SAVE THEIR LIVES, as well as increasing targets that cause us to have to run around like chickens with our heads cut off rather than focus on the task at hand. The liability and the litigation against nurses is increasing causing us to spend more time than anything covering our asses via documentation. If you didn't document it...than you DIDN'T DO IT. That is the rule and if you don't adhere to that you GET BUSTED.

Meanwhile the HCA's are spending most of the time doing patient care (i.e assistance with activities of daily living). I don't have a choice but to let that happen because I am so overwhelmed but it scares the living fuck out of me. If I bathed my own patients, fed them, and walked them to the loo I can do a hell of a good holistic nursing assesment during that time and decrease the risk of getting fucking slaughtered by the NMC. I will notice how you are breathing while bathing you. An HCA will not or may not connect any dots. I will notice if you are showing signs of internal bleeding, shock, neurological changes, drug reactions, dehydration, pneumonia, hypoxia, infection, etc etc etc ad nauseum. I will catch problems during this time and sort them. An HCA will bath you and go onto the next patient because she doesn't know any better. Does the term "Failure to rescue" sound familiar? Most HCA's are lovely and hardworking but they do not have a license or professional accountability. If they fuck up I am fully responsible. They can't connect the dots between your appearance on a good head to toe assesment and your meds, labs, etc.

Am I able to provide basic care and do a good nursing assesment of each of my patients during this basic daily activity? NO.

Am I forced to dump things like bed baths on the HCA's? Yes.

Does that mean that my patients problems are not getting noticed quick enough? Yes.

Are nurses happy about this? Hell No.

We are scared shitless. Doing simple bedbaths allows me to do a thorough assesment that can help a patient, catch trouble brewing and keep my cute little bottom out of trouble. We are not "too posh to wash". We are "pulled in too many directions at once to wash" and we hate this because we can't get a good handle on our patients general condition which leaves us open to litigation, as well as a lifetime of guilt. Plus you just look fucking stupid when you don't know that your patient has sore heals. a sacral sore and a cellulitic looking leg and you have been "caring" for him 2 shifts in a row.

In later posts I will talk about nursing assesments how much I learn about your general condition during a 2 minute chat and a bedbath, or a simple walk to the toilet. That assesment at the beginning of my shift can make or break you (and me). I believe that all care should be carried out by an RN with a small number of patients. I believe that I should have a smaller number of patients and do everything for them from hanging IV meds, assesments, care-planning, to wound care, and to cleaning their damn feet. Pedal pulses anyone? This is how I feel and yet I have no choice but to leave the bathing and the mobilizing and the talking to my patients to the HCA's. No choice whatsoever.

Where are the signs of horror regarding low patient ratios and a mass exodus of actual nurses from the bedside? Why doesn't the public care? Why aren't they worried and crying out regarding the dangers of short staffing? Because to them a nurse is simply the hospitals version of waitressing staff, and doctors (who are rarely ever on the wards) are somehow watching the nurses' every move and the patient's condition. Therefore nursing care is really no big deal.This is what sets the stage for poor care in hospitals. Nurses are an easy target for managers, and we are one of the first things to get culled back when they need to balance the books. Until people realize just how important nursing care is and that we need lots of actual nurses around care will continue to deteriorate.

Tuesday, 18 September 2007

Found this article during my web travels. Maybe my image for this post should have said "different day, different country, SAME OLD SHIT. This article is pretty old...2001 but it says a lot of things that are pertinent now. My belief is that things have really deteriorated since this article was written.

This piece is also American as is most of the other stuff I posted. It may be American but the stories that these nurses are telling could have come straight out of the mouths of British Nurses. I want to start seeing this stuff from British Journalists.

My lovely comments in bold.

Look, if you don't think that "medical economics" isn't completely fucking with the system here as much as it is in the USA than I am worried. Good care is no longer a priority. Making it appear that good care is the goal is the priority now. It doesn't matter if you are in an NHS hospital in Crapshire or BigBucks hospital in Bumblefuck,Wisconsin. It's all the same.

Same shit different country has always been my motto.

Prognosis poor in nursing shortage

Sunday, September 09, 2001

By Ford TurnerOf The Patriot-News

Nurse Kelli Diodato, less than two years out of Penn State University, worked at Harrisburg Hospital and had to care simultaneously for up to eight heart patients. People with "all kinds of IVs and chest tubes and lines in their arteries."

Diodato calls it "ridiculous." Four patients, she says, might have been an appropriate number.

Remember that advances in technology means that hospital patients are sicker, more complex and tougher to take care of than they were years ago.....Anne

One night last year, a supervisor insisted Diodato take responsibility for nine patients at one time. That night, she decided to get a new job.

"I just wasn't able to give the care I wanted. ... I felt rushed and I didn't have time to do complete assessments the way I wanted to do them. I was overwhelmed," Baer says.

Baer recently started a new job as a $9.25-an-hour middle-school health aide. ***

Sally Long, a nurse at Harrisburg State Hospital, says she has watched mentally ill people go to other hospitals for medical problems, only to lie in the emergency room -- sometimes for days -- until the hospitals have staffed, non-emergency beds available.

"In the last few months I've seen it happen half a dozen times, and really one time is too many," she says. ***

Ask a hospital nurse, hear a disturbing story.

Piece the stories together, form a disturbing portrait.

Hospital nurses in central Pennsylvania are running themselves ragged in the face of a national nursing shortage. Jesus are they talking about the UK?...Anne

They speak of stress, understaffing, and a widespread belief that the health care system puts money ahead of patient care. Veteran registered nurses -- the backbone of hospital nursing staffs -- are resigning in large numbers. Relatively few people are coming into the profession; hospital managers patch holes by hiring "temp" nurses and even by recruiting overseas.

Sound familiar? Would a UK hospital cull back staff to try and stay within budget? Would they pay out to bring in cheaper foreign nurses who aren't as likely to speak out when patient care is compromised? The correct answer is.... fuck yes........Anne

Of some three dozen midstate nurses interviewed by The Patriot-News, many say the shortage is compromising patient care, directly or indirectly.

They aren't alone.

Concern has grown nationwide over how patients are faring in the face of a shortage dramatized by some startling statistics:

Put a registered nurse in every one of the 106,537 seats at Penn State's Beaver Stadium, and cram about 20,000 more onto the football field -- that's how many nurses it would take to solve the nation's shortage. The number of people passing the national registered-nurse exam dropped 23 percent in the past five years, from about 98,000 to about 75,000, according to the General Accounting Office.

Yet there are over 500,000 licensed Registered Nurses in the USA who refuse to work in healthcare. The UK is heaving with Registered Nurses who will not work in Nursing. They all say the same thing....Love Nursing/Hate the overwhelming work loads and sheer terror that the job entails (and don't even get me started who the unreasonable public who demands one on one care from a nurse they are sharing with 20 other sick patients...........Anne

Enrollments in Pennsylvania nursing schools -- those offering standard entry-level programs -- has dropped by more than 35 percent since 1995, from about 5,800 to 3,800, according to the American Association of Colleges of Nursing. More than 40 percent of U.S. hospital nurses reported dissatisfaction with their jobs in a University of Pennsylvania study.

Two recently released studies -- one by Harvard and Vanderbilt universities, the other by the federal government -- concluded that care improves when more nurses are available. Although there have been nursing shortages in the past, this one is expected to last longer and hurt more. It is a numbers problem: The demand for nurses will surge as baby boomers reach their senior years. At the same time, the number of women between ages 25 and 54 -- the traditional core of the nurse work force -- is expected to remain unchanged.

But studies and statistics fail to convey the human side of nurses' everyday struggles.

Opportunities grow:

"Sometimes I come home and I cry," says one nurse who has worked at both Harrisburg and Holy Spirit hospitals. "People are really sick and they need good care." ***

"We feel kind of torn. We want to give the best care we can, and we do, but you fly around like a crazy person," says Christy Clippinger, a 36-year-old registered nurse who works in the operating room at Harrisburg Hospital.

***

Many things get blamed for the nursing shortage, including more opportunities for women outside of nursing, discontent among nurses, and staff cuts as managed care squeezes hospital finances.

With enrollment at U.S. nursing schools down from about 74,000 in 1995 to 58,000 last year, there are "fewer nurses in the educational pipeline," says a spokesman for the American Association of Colleges of Nursing.

The urgent question: Why?

"Girls aren't going into nursing anymore," says Lebanon resident Marie Garman, a licensed practical nurse for 35 years. "I don't know if they think it's demeaning or what, but it's not being pushed in high schools anymore, either."

Well I have banned my own daughter from a career in nursing. I wouldn't encourage anyone to enter the field. If you go to university and study anything else you will make more money, not have to know as much, not have to work as hard, work better hours and get more respect. It's a no brainer.......Anne

Meanwhile, non-nursing opportunities for women have exploded.

Leanne Clark, a 53-year-old nurse at Harrisburg Hospital, says that when she got out of high school "a woman either became a teacher, a secretary, a beautician or a nurse."

The wives of President Bush and Gov. Tom Ridge are librarians.

Today, women have opportunities in business, the military -- just about any field they choose.

Meanwhile, nurses' place in the health care system has changed dramatically.

Bill Cruice, director of the Pennsylvania Association of Staff Nurses and Allied Professionals in Conshohocken, says he believes the health care industry inflicted the shortage upon itself.

When managed care, in the mid-1990s, "decided that the health system would be driven by profit -- accountants and fancy consultants peddling their wares -- the entire atmosphere of what it meant to be a professional nurse on the front lines changed," he says. "Almost overnight it made being a nurse one of the most difficult jobs in the country."

Many hospitals cut 50 or more nursing positions as they sought to reduce costs in the late 1990s, says Jessie Rohner, executive administrator of the Pennsylvania State Nurses Association.

After that, he says, nurses felt no loyalty to their former employers. It became difficult to lure them back to the hospital.

Nurses also have seen job demands increase. Not just in patient care, but in scheduling.

Overtime -- described by some nurses as "mandatory," though most hospitals reject the term -- has become a drain on their lives. Some are told to work extra shifts every week. Others stay at work after their shift ends because they are a "DL," or designated late, nurse.

"When you work so many hours, you just aren't as good as you were at 7 a.m.," says a veteran nurse in the PinnacleHealth System.

Lydia Mogel, a nurse at Penn State Milton S. Hershey Medical Center, says her colleagues come to work sick "because if they call in sick, they get an 'occurrence' ... a written record that goes in your file."

Many nurses say the exodus from their profession is linked to a sea change in health care. Profits, they say, have become more important than patient care.

Profits/Targets/Budgets...whatever. Yes hospitals have to be fiscally responsible and not piss money away. But they have to make sure that they are putting the money into the right areas. Patient care would be a good start.......Anne

Their feelings are shared by Kerry M. Fagelman, a pediatric surgeon who practices at several midstate hospitals.

The shortage of nurses, he says, is compromising care in every hospital because the number of nurses available "has a direct impact on patient care and on patient mortality."

However, Fagelman -- who spent four years in medical school, eight years as a surgeon in training, and has had a surgical practice for 19 -- says the nursing shortage is one symptom of a much larger problem of "medical economics."

In short, he says, medicine has become a business in which health insurance companies and health care organizations suck away money that should go to providers such as nurses and doctors.

Sometimes they suck it away and put it towards stupid shit like more managers and paperwork as well as fucking stupid targets that merely give the appearance of better patient care. They resent having to provide nurses and doctors to care for patients let alone shuffle money their way in exchange for their hard work.....Anne

"It has come not to care, but to the dollar figure. How quickly can we get those patients in and out ... The care is not there that was there 10 years ago," says Cindy Fetchen, a 42-year-old registered nurse who works in operating rooms at Hershey Medical Center. ***

A 10-year veteran nurse at PinnacleHealth says: "It is more greed, toward money. It is a business. It is not geared toward the patient." She points to the recent shutdown of adult outpatient mental health services by PinnacleHealth as one example. ***

Another veteran PinnacleHealth nurse who requests anonymity says that, because of the nursing shortage, Harrisburg Hospital at times has had only nine of its 19 operating rooms functioning.

The crunch means patients sometimes are processed in a hurry.

The nurse says she saw surgeons ask for patients to be brought into surgery with prep work incomplete.

In April, the state fined PinnacleHealth for that very problem, along with an apparent breakdown in the procedure that surgeons use to verify the identity of some surgical patients. ***

While nurses are frustrated, they aren't complaining in a vacuum. Hospital officials acknowledge, and even echo, their complaints.

"Our job right now, as far as I am concerned, is to listen to them and understand what is going on in their work life, and try as much as we can to respond to it," says Roger Longenderfer, chief executive officer of PinnacleHealth. "We use a significant amount of agency nurses and temporary help -- that's a very short-term solution. We'd much rather have our own folks in place, but that does help fill the gaps to some degree."

A chief executive who gives a damn? Fuck. Where did they find him? I don't know which planet this bloke is from but it certainly isn't Earth. This statement makes it sounds like he gives a shit. Can't be. Either he is lying or he's not of this world. ....Anne

"What we want to pay special attention to is working to keep enough nurses on the front lines delivering direct care," says Darrell G. Kirch, president and chief executive of Hershey Medical Center.

You have got to be shitting me.....Anne

Julie Miksit, administrative director of nursing at Good Samaritan Hospital, says creative solutions have allowed the hospital to retain nurses and keep patient safety at a proper level. The hospital has not resorted to mandatory overtime and patient care is not being compromised, she says.

Still, nurses agree that, whether patient safety is affected or not, the shortage robs them of time to give hands-on, bedside assistance, or consoling, friendly conversation -- some of the things that drew them to nursing in the first place.

"My sister was diagnosed with breast cancer and died a year later. That strengthened my need to nurture. Sometimes I say, 'I'm going to leave nursing,' but then something happens to make me see the rewards," says Ivy Matthews, who works in the hospice unit of the VA Medical Center in Lebanon. ***

"I wanted to be a nurse since I was little. My brother was asthmatic since he was a baby. One day I stood on the porch while he turned blue, and I didn't know what to do. I wanted to be able to do something," says Lebanon VA nurse Penny Riehl. ***

Lawmakers have heard the hue and cry of nurses.

Still waiting for this to happen in the UK. I have watched what has happened in the USA over the last 10 years with nurses getting politically active. It hasn't been pretty. The health care lobby is pretty powerful. I have higher hopes for the UK really......Anne

A bill introduced in the state Legislature would limit services that may be performed by unlicensed hospital personnel. Another would protect whistleblowers who report problems at hospitals. A third would mandate the Pennsylvania Health Care Cost Containment Council to collect information on the quality of hospital care.

As far as I know this bill failed in Pennsylvania. The health care lobby is too powerful.......Anne

Rep. Pat Vance, R-Silver Spring Twp., a former nurse, said remedies for the shortage might include establishing a "career ladder" to give nurse's aides more opportunities to become nurses.

Is she on crack? Nurses aides and HCA's don't want to become nurses. They know the score. The fucking nurses want to be HCA's.......Anne

Meanwhile, hospitals are going to great lengths to recruit nurses.

Total fucking lie. I know this region and lived near there around the time this article was written. They made it appear that they were trying to recruit and retain. Kind of like what the NHS is doing now........Anne

Holy Spirit and other hospitals offer "signing bonuses." Lancashire Hall nursing and rehabilitation center in Manheim Twp. has recruited 18 nurses from the Philippines, and 155 other Filipino nurses could be working in area facilities within the next few months.

What about all of the experienced home grown nurses? Don't want to bring them back because they'll blow the whistle on your dangerous practices right fucko?want more pay for having more experience and responsibility. We can't have that now can we?....Anne

The real key, many agree, is to think ahead.

"Trying to market nursing as a good career is where we need to go to attract people to the field," says Good Samaritan's Miksit.

Yeah, Market it all you want. The job sucks. You are just training more nurses to burn them all out and turn them into ex-nurses after 2 years in the field......Anne

"You need to look at recruitment in high school and in junior high and have people with a positive attitude talking about it," agrees Lebanon nurse Marie Garman.

Guess that's me out then...as well as any other frontline nurse........Anne.

The health care system may first have to heal the day-to-day experience of those who should be their strongest recruiters: the men and women on nursing's front lines.

Care diminished:

"The treatments may be given. The bandages may be changed," says Colleen Swisher, who works in an intensive care unit at Holy Spirit. "But, when they are in pain, or they are anxious, or they are emotionally distraught ... if somebody can't be there, they aren't getting the care they deserve. And that happens all the time." ***

One 19-year veteran says she quit her full-time job at Harrisburg Hospital because, as a nurse, "What they are expecting of you is physically impossible to do safely."

Most journalists (especially the ones who write about hospitals) are morons. Occasionally Journalists do get stuff right. I have stumbled upon a couple of articles that demonstrate this rare phenomenon. Both of the articles I am posting here are American but the things they are talking about apply to UK nurses as well. I wish the British media would do this.

We have the same problems occurring on both sides of the pond in completely different health systems. I have worked in both the USA and the UK as an RN and I have always said that there are more similarities than differences...this is especially true when it comes to nursing. On both sides of the pond healthcare has been enslaved by the almighty dollar (or pound). The people running the hospitals do not see nurses as educated professionals who are crucial to patient safety. They see nurses as an expense that they want to do away with.

They will happily send a ward nurse an unstable patient who needs her constant presence at their bedside to survive the shift on top of 20 other patients who all need massive amounts of care. They will then refuse to send her another nurse or any kind of help citing money as the main problem. They know that people will assume that the shitty care those other 20 patients have received are a result of horrible lazy nurses. They won't have angry relatives screaming at them...the overwhelmed nurse will have that while she is busy trying to get blood hung on the guy with the GI bleed. If a patient was harmed in that situation do you know who the law would go after? The nurse. Fact.

Many good nurses have lost their registration due to situations like this one. The boards of nursing in the USA and the NMC here in the UK have taken an interesting stand on these situations. Their view is that a nurse is a professional and that if she agrees to take on a dangerous amount of acutely ill patients than she is liable. Completely. Their advice to us is that we need to get away from an employer who won't staff properly or we are liable and they will take our pin numbers so that we can never work in healthcare again. I have a written letter from them stating this. Their advice was to refuse a dangerous assignment as it is better to get fired and anger your manager rather than end up in court.

There are three problems with this stand by our nurse licensing organisations: first of all nurses have families and mortgages and financial commitments and can't just pack in their jobs. The second problem is that the UK has a complete recruitment freeze going on at the minute and there are NO JOBS. NONE. Most of our new grad nurses are unable to find employment. The third problem is that if you do take a stand and refuse to take on a dangerous assignment you will not only lose your job but get blacklisted and never get another. I have seen them give bad references and take disciplinary action against a nurse because they have refused to be the only nurse on a 30 bed ward. Two of these nurses are currently on the dole.

There is nothing forcing the managers to staff the wards safely. Nothing. This is why everyone is getting the hell away from the bedside. If you think they are getting out and going quaktitioner because they are too posh to clean up faeces and simply want to advance and get more pay you are mistaken. It's the impossible the workloads and the liability that are causing the nurses to flee. Nurses love nursing they just don't like abuse. More nurses are escaping the bedside completely by leaving healthcare all together. A very very small number are going into "advanced roles". If you go to feed that patient or clean up the other one who is lying in filth the time you spend away will kill one of your other patients. Patients weren't as unstable years ago. People like this died quickly and back then it was accepted.

I am hoping that British journalists will talk to nurses who are CURRENTLY working in our hospitals. I want to see them do research rather than the usual "nurses don't wash their hands and leave you in your own filth because they are mean" tabloid rubbish. I want our hospitals to improve. This is never going to happen until people in general realise that nurses are important and that we need lots of them. We already KNOW that having more nurses saves more money than it costs because of the reduction in expensive patient complications as well as inpatient stays. I am talking about Registered Nurses here...not the minimum wage paid housekeeper who was taught how to take a blood pressure and wears a uniform nearly identical to mine.

Nurses who have left nursing have said that it is going to take less patients and better working conditions to get them back into the profession. Having to clean up shit and puke are the least of our worries and the easiest part of the job really.

Our abhorrent salaries are the least of our worries.

Simply paying more money to nurses isn't going to fix anything.

In the USA an RN who has just qualified (including diploma and associate degrees) start at a salary of about $50,000-$55,000. In some places it is up to $60,000-$70,000. This is far higher than the salary that most university graduates obtain in the beginning. . Nurses earn more than policemen, social workers, and teachers. There is a lot of room to grow and it's fairly easy to bring in a 6 figure salary annually if you pick up lots of overtime. Nurses in the UK are banned from overtime right now and mandatory over time is completely unpaid. But even with a decent salary and wickedly awesome overtime pay USA hospitals cannot retain their nurses.

"In nursing, pay isn't the only issue. Difficult working conditions and understaffing also deter qualified people from pursuing the profession (see BusinessWeek.com, 8/21/07, "Labor Shortages: Myth and Reality"). But average annual wages for registered nurses (one of the most highly trained categories) is now just under $58,000 a year, compared with a $36,300 average for U.S. workers overall. And it's clear that qualified American nurses see that as not enough: There are 500,000 registered nurses who are not practicing their profession—fully one-fifth of the current RN workforce of 2.5 million and enough to fill current vacancies twice over."

"While nurses' advocates say better pay is critical, they also argue that working conditions must improve if the U.S. is to cultivate an enduring nursing workforce. Future projections of staffing troubles are ominous. The current 8.5% shortage is expected to surge to 29%—or more than 810,000 nurses—by 2020, according to the U.S. Health & Human Services Dept. "You will draw in some people with a good pay raise, but you won't necessarily get them to stay," says Cheryl Johnson, a registered nurse and president of the United Association of Nurses, the largest nurses' union in the U.S. "Almost every nurse will tell you that staffing is a critical problem. The workload is so great that there's not time to see how [patients are] breathing, give them water, or turn them to prevent bedsores. The guilt can be unbearable."

You wouldn't even believe the figure of qualified British nurses who are living in Britain and refusing to work as nurses so I won't post it. The hospitals would refuse to hire them anyway. They want the registered nurses out.

Basically the Americans are paying their nurses more money and still nurses who love nursing don't want to do it. In the UK we are paying them absolute shit and yet nurses who love nursing don't want to do it. Check out some of the comments on that article. Could have been written by any nurse at my hospital.

Experienced well educated nurses who are dedicated to nursing are leaving the profession in droves and their managers are loving it. We train more nurses and they (well the ones who can find a job anyway) burn out quick. We burn them out faster than we can train them. What the fuck is going on? The bottom line is that healthcare revolves around money and nurses are seen as a cost. The powers that be don't even really know what a nurse does or what they are responsible for. They don't understand the outcomes that patients have when there are too few nurses. To these guys nurses are just a part of a budget that needs to be reduced. An inexperienced nurse is cheaper. A foreign nurse who can't speak english is cheaper and more likely to take abuse and accept dangerous workloads because he/she doesn't understand the law.

I have so many sick patients and I'm so scared that I am often throwing up before work due to nerves. I am not the only one at my hospital who feels this way. We have so many patients we can't even remember all of their names and medical problems. The whole shift becomes a rat race trying to run from one task to the next with constant interruptions. I can easily be halfway through 18 jobs at any given time. Then the consultant shows up to do rounds and wants information from me on people who I haven't even seen. Haven't even been able learn about them. Forget about being able to look in their notes or spend any time with them at any point during your 15 hour shift. We are not nursing we are putting out fires all day. Ninety-nine percent of us want to do real nursing. Most of us working today trained in the "the good old days".

Sometimes people stop breathing at mealtime. Sometime post-op patients come back to the ward at mealtime. Sometimes patients have a seizure at mealtime. Sometimes 8 people need pain killers at mealtime. Lots of times all this happens all at once at mealtime. There is no one to feed my other 12 patients who are unable to feed themselves. I am then accused of "letting people starve because I can't be bothered with real nursing care". Had I let any of that stuff go and fed my patients first I would be in court real fast. We rarely have doctors on the wards as they don't have ward based doctors at my hospital so it's not like they can do CPR while I feed everyone.

We ask management to please allow us to have help at mealtime. They have literally (oh yes) responded with "piss off". No they are not running around trying to get nurses in because they care about patient care. Quite the opposite in fact. These bastards don't even understand the link between staffing and patient care. I'm sure our chief executive doesn't understand the difference between a nurse and a porter. They want to save money.

So so afraid someone will die because I can't be 10 places at once and I will be charged with manslaughter. This is not an unreasonable fear but a very valid one. This was confirmed for me after I spoke to the NMC and an attorney who was once a nurse. The people who refuse to send any staff will have no comeback and that is the truth. It makes me so angry.

More patients+ more patients with increasingly complex problems+less nurses due to intentional short staffing = horrible care and nurses getting a bad reputation. They get verbally and physically abused. They become burned out. We are losing more bedside nurses to this than anything. Would an abused wife stay in a marriage where her husbands beats her if someone offers her more money?

What would happen of all the burned out nurses who left the beside decided to come back and work? Would that fix the problem? Nope. The hospitals wouldn't hire them. They don't want them. They don't want the new grads either. There are no jobs in the UK and they are getting harder to find in the USA. It's just one big roaring nightmare and I don't know how to make these people listen.

Friday, 14 September 2007

I am angry because the nursing profession has been destroyed. Nurses are working harder than ever in a rapidly changing environment. Changes in medicine and the way health care is delivered has tripled the workload of hospital nurses. Nurses are caring as well as hard working and we DO CARE about our patients.

The problem is that even the most wonderful, professional, hardworking and caring nurses in the world are not able to cope with their workloads. On average a nurse spends less than 15 minutes with each patient during her 12-14 hour shift. Yet he/she is working so hard that they probably worked 14 hours without eating or even being able to pee. Not only is your nurse working 12-14 hours or more without being able to eat or pee but she is absolutely terrified. Nurse needs to be 10 places at once or someone will suffer or die and nurse gets into big trouble with the law. Patients and visitors want a one to one handmaiden with no concept of how many other patients a nurse has or what is going on with them. Nor do they understand the consequences of the nurse not prioritising correctly. Where are the managers in all this? They are intentionally short staffing the wards knowing full well that the public will take their anger out on the one nurse running her ass off between 30 patients.

Why is this happening? Hospital managers (whether you are in the USA or the UK) only care about money. They are INTENTIONALLY SHORT STAFFING THE WARDS. They are refusing the hire. They don't want to retain their nurses and love to see them burn out and quit. Good nurses are leaving the profession in droves because they are overwhelmed and frightened and cannot stand seeing their patients suffer. I am going to use this blog to focus on these issues. The managers need to be dealt with and the public needs a reality check and they also need to understand what is really going on.

I will start off with asking anyone who has bothered to read this far to look at this petition.

"A growing body of research evidence shows that increases in the number of patients cared for by each nurse leads to increases in hospital-acquired infections, pressure ulcers, malnutrition, dehydration and patient mortality. This also leads to increased levels of stress, demoralisation and "burn-out" among nurses. We therefore feel it is vital to tackle the understaffing of hospital wards. The government should set statutory minimum nurse: patient ratios, with penalties for NHS Trusts that fail to achieve these ratios."

Having set standards regarding staffing not only saves patients lives and reduces complications but it also saves money. Hospitals that have done this have seen their number of complaints plummet. Complaints are a huge expense for the NHS and all hospitals. Hospitals that have implemented this program have also seen their medication and other error rates dramatically decrease. They save more money by having more registered nurses on the wards. Study after study has shown that intentional short staffing by managers is not only dangerous but really very expensive. Registered nurses do make a difference. The managers want as few of them on the wards that they feel they can get away with in order to try and meet their budgets and save money. Having too few nurses around actually has the opposite effect.

Nurses and researchers have known for years that we are not short of qualified nurses...we are short of nurses who are willing to work in hospitals due to the insane and dangerous conditions. These conditions cause nurses to feel overwhelmed and leave. It destroys their health. We train more nurses but we cannot retain them at the bedside due to overwhelming, chaotic and dangerous working conditions. Set nurse patient ratios will allow hardworking nurses to do their jobs and keep nurses nursing. Employing more bedside registered nurses leads to a reduction in expensive patient complications as well as complaints and also saves big money. An astonishing number of qualified British nurses no where near retirement age leave the profession every year due to impossible workloads and increased liability.

If you need to know more and want to see stats and research done on this very subject look here and scroll down: http://www.nursingadvocacy.org/faq/short-staffed.html . If you don't look at this research you probably won't understand what the hell I am on about in this blog.

Nurse are not to posh to wash or too clever to care. We are overloaded and forced to make some really tough deciscions about which one of our multiple patients (who ALL need help now )gets care. Making the wrong decision lands your arse in court and kills someone. Meanwhile all of the "support staff" who have no liability hang around at the nurses station dressed in uniforms nearly identical to ours. That isn't to say that we don't have some excellent support staff that have a very difficult job. My big concern is that the patients/visitors don't know who is who. But that is a whole different topic.

The media and the politicians are abusing and devaluing both doctors and nurses. Yet the doctors are so close minded that they believe that they are the only ones who are the victims of this smear/spin campaign by the powers that be. Doctors jump on the "nurses leave people to lie in their on shit and starve because they don't care" bandwagon just as much as everyone else does. I can forgive the journalists/politicians/and joe public for not having a clue and being ignorant about what's going on with nursing care....but I can't find it in my heart to forgive the doctors. They should know better.

I am also a bit annoyed with former nurses who left the profession in 1982 and haven't been in a hospital since that time who are slagging off the younger nurses. They understand the situation like my hamster understands algebra. It's reality check time. Things are not always as they appear folks.

In an atmosphere if universal deceit telling the truth is a revolutionary act. George Orwell.

Why has Nursing Care Deteriorated

Good nurses are failing every day to provide their patients with a decent standard of care. You want to know what has happened? Read this book and understand that similiar things have happened in the UK. Similiar causes, similiar consequences. And remember this. The failings in care have nothing to do with educated nurses or nurses who don't care. We need more well educated nurses on the wards rather than intentional short staffing by management.

About Me

I am a university educated registered nurse. We had a hell of a lot of hands on practice as well as our academic courses. The only people who say that you don't need a brain or an education to be an RN are the people who do not have any direct experience of nursing in acute care on today's wards. I have yet to meet a nurse who thinks that she is above providing basic care. I work with nurses who are completely unable to provide basic care due to ward conditions.
I have lived and worked in 3 countries and have seen more similarities than differences. I have been a qualified nurse for nearly 15 years. I never used to use foul language until working on the wards got to me. It's a mess everywhere, not just the NHS.
Hospital management is slashing the numbers of staff on the ward whilst filling us up with more patients than we can handle... patients who are increasingly frail. After an 8-14 hour shift without stopping once we have still barely scratched the surface of being able to do what we need to do for our patients.

Quotes of Interest. Education of Nurses.

Hospitals with higher proportions of baccalaureate-prepared nurses tended to have lower 30-day mortality rates. Our findings indicated that a 10% increase in the proportion of baccalaureate prepared nurses was associated with 9 fewer deaths for every 1,000 discharged patients."...Journal of advanced nursing 2007

THIS MEANS WE NEED WELL EDUCATED NURSES AT THE BEDSIDE NOT IN ADVANCED ROLES

Dr. Linda Aiken and her colleagues at the University of Pennsylvania identified a clear link between higher levels of nursing education and better patient outcomes. This extensive study found that surgical patients have a "substantial survival advantage" if treated in hospitals with higher proportions of nurses educated at the baccalaureate or higher degree level.

THIS MEANS WE NEED WELL EDUCATED NURSES AT THE BEDSIDE NOT IN ADVANCED ROLES

Dr. Linda Aiken and her colleagues at the University of Pennsylvania's Center for Health Outcomes and Policy Research found that patients experienced significantly lower mortality and failure to rescue rates in hospitals where more highly educated nurses are providing direct patient care.

Evidence shows that nursing education level is a factor in patient safety and quality of care. As cited in the report When Care Becomes a Burden released by the Milbank Memorial Fund in 2001, two separate studies conducted in 1996 - one by the state of New York and one by the state of Texas - clearly show that significantly higher levels of medication errors and procedural violations are committed by nurses prepared at the associate degree and diploma levels as compared with the baccalaureate level.

Registered Nurse Staffing Ratios

International Council of Nurses Fact Sheet:

In a given unit the optimal workload for a registered nurse was four patients. Increasing the workload to 6 resulted in patients being 14% more likely to die within 30 days of admission.

A workload of 8 patients versus 4 was associated with a 31% increase in mortality. (In the NHS RN's each have anywhere from 10-35 patients per RN. It doesn't need to be this way..Anne)

Registered Nurses in NHS hospitals usually have between 10 and 30+ patients each on general wards.

Earlier in the year, the New England Journal of Medicine published results from another study of similar genre reported by a different group of nurse researchers. In that paper, Needleman et al3 examined whether different levels of nurse staffing are related to a patient’s risk of developing complications or of dying. Data from more than 5 million medical patient discharges and more than 1.1 million surgical patient discharges from 799 hospitals in 11 different states revealed that patients receiving more care from RNs (compared to licensed practical nurses and nurses’ aides) and those receiving the most hours of care per day from RNs experienced fewer complications and lower mortality rates than those who received more of their care from licensed practical nurses and/or aides. Specifically for medical patients, those who received more hours per day of care from an RN and/or those who had a greater proportions of their care provided by RNs experienced statistically significant shorter length of stay and lower complication rates (urinary tract infections, gastrointestinal bleeding, pneumonia, cardiac arrest, or shock), as well as fewer deaths from these and other (sepsis, deep vein thrombosis) complications

•Lower levels of hospital registered nurse staffing are associated with more adverse outcomes such as Pneumonia, pressure sores and death.
•Patients have higher acuity, yet the skill levels of the nursing staff have declined as hospitals replace RN's with untrained carers.
•Higher acuity patients and the added responsibilities that come with them increase the registered nurse workload.
•Avoidable adverse outcomes such as pneumonia can raise treatment costs by up to $28,000.
•Hiring more RNs does not decrease profits. (Hospital bosses don't understand this. They think that they will save money by shedding real nurses in favour of carers and assistants. The damage done to the patients as a result of this costs more moneyi.e expensive deaths, complications,and lawsuits, and complaints....Anne)

Disclaimer

I know I swear too much. I am truly very sorry if you are offended. Please do not visit my blog if foul language upsets you. I want to help people. That is why I started this blog and that is why I became a Nurse. I won't run away from Nursing just yet. I want to stick around and make things better. I don't want the nurses caring for me when I am sick working in the same conditions that I am. Of course this is all just a figmant of my imagination anyway and I am not even in this reality. Or am I?Any opinions expressed in my posts are mine and mine alone and do not represent the viewpoint of the NHS, the RCN, God, or anyone else.